Precision medicine in adult and pediatric obesity: a clinical perspective

Abstract

It remains largely unknown as to why some individuals experience substantial weight loss with obesity interventions, while others receiving these same interventions do not. Person-specific characteristics likely play a significant role in this heterogeneity in treatment response. The practice of precision medicine accounts for an individual’s genes, environment, and lifestyle when deciding upon treatment type and intensity in order to optimize benefit and minimize risk. In this review, we first discuss biopsychosocial determinants of obesity, as understanding the complexity of this disease is necessary for appreciating how difficult it is to develop individualized treatment plans. Next, we present literature on person-specific characteristics associated with, and predictive of, weight loss response to various obesity treatments including lifestyle modification, pharmacotherapy, metabolic and bariatric surgery, and medical devices. Finally, we discuss important gaps in our understanding of the causes of obesity in relation to the suboptimal treatment outcomes in certain patients, and offer solutions that may lead to the development of more effective and targeted obesity therapies.

Low-Carbohydrate Diets in the Management of Obesity and Type 2 Diabetes: A Review from Clinicians Using the Approach in Practice

“…Furthermore, commercial meal replacement programs can be expensive, with some analyses suggesting they are prohibitively cost ineffective [13]. Drug treatments are available [14], but as with lifestyle interventions, there is heterogeneity both in how much weight is lost and the improvements seen in glycemic control with different medications [15]. Bariatric surgery is efficacious and cost effective [16], particularly in patients with type 2 diabetes, where sustained remission is feasible for a substantial proportion of patients [17].…”

When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity

“…A recently published international consensus statement about the stigma of obesity addressed the impact of unproven assumptions that attribute body weight to a lack of self-discipline and personal responsibility (Rubino et al, 2020). Weight stigma, discrimination, and bullying can lead to maladaptive eating which increases risk for unhealthy weight in susceptible children ( Bomberg et al, 2019 ; Puhl, Himmelstein, & Pearl, 2020 ). Weight-based teasing, whether in person or in cyber space, can lead to further weight gain as a response to stress ( Schvey et al, 2019 ).…”

Inter‐individual differences in body mass index were not observed as a result of aerobic exercise in children and adolescents with overweight and obesity

“…33 This includes an increased interest in the use of precision medicine, also known as personalized medicine, for the prevention and treatment in those with overweight and obesity, an approach that incorporates individual variability in the genes, environment, and lifestyle for each individual. [34][35][36] The assumption of precision medicine is that true inter-individual differences exist, for example, responders and nonresponders, to an intervention. While it has been suggested that inter-individual variability exists with respect to exercise-associated changes in adiposity among children, adolescents, and adults, [37][38][39][40][41][42][43] the focus of these studies has been on group mean data with little regard to inter-individual variation in which differences in change outcome standard deviations between both the exercise and control groups are examined.…”